Survival outcomes and prognostic indicators for gastric cancer patients with positive peritoneal wash cytology but no peritoneal metastasis after radical gastrectomy

BACKGROUNDPositive peritoneal wash cytology with no peritoneal metastasis (CY1P0) is a special type of distant gastric cancer metastasis, which describes a patient with positive peritoneal lavage cytology, but no definitive peritoneal metastasis, and there are no widely accepted treatment guidelines. We enrolled 48 primary CY1P0 gastric cancer patients treated by radical gastrectomy in this study. Our study illustrated the efficacy of radical gastrectomy for CY1P0 gastric cancer patients, and suggested that the pathological N factor and vascular invasion were significant independent risk factors for overall survival (OS). AIMTo assess the survival of CY1P0 gastric cancer patient post-radical gastrectomy, and to identify factors associated with long-term prognosis.METHODSOur study included 48 patients with primary CY1P0 gastric cancer who had radical gastrectomies at the Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China between 2013 and 2018. R0 resection was achieved in all 48 patients. Twelve patients received neoadjuvant chemotherapy. Thirty patients received adjuvant chemotherapy and four received adjuvant chemoradiotherapy. OS statistics were available for 48 patients. Follow-up continued through March 2020. Univariate and multivariate analyses were performed using a Cox proportional hazards model to identify prognostic factors. RESULTSMedian OS was 22.0 mo (95% confidence interval: 13.366-30.634 mo) post-surgery. Univariate analyses demonstrated that tumor site (P = 0.021), pathological N factor (P = 0.001), pathological T factor (P = 0.028), vascular invasion (P = 0.046), and the level of CA199 prior to initiating therapy (P = 0.002) were significant risk factors for OS. Multivariate analyses demonstrated that pathological N factor (P = 0.001) and vascular invasion (P = 0.031) were significant independent risk factors for OS.CONCLUSIONThis study suggested that radical gastrectomy may be efficient for CY1P0 gastric cancer patient post-radical gastrectomy and the pathological N factor and vascular invasion are significant independent risk factors for OS.     

Preoperative diagnostic laparoscopy with local anesthesia and lavage telomerase activity for advanced gastric cancer

A pretherapeutic staging system to design operative or neoadjuvant treatments in gastric cancer is needed. In this study, a simple staging system based on diagnostic laparoscopic findings under local anesthesia to define a treatment was developed. This study was conducted with 68 patients with advanced gastric cancer. All the patients had been diagnosed as more than T3, or were suspected to have peritoneal seeding. Preoperative diagnostic laparoscopy under local anesthesia was performed in the operation room. After insertion of the trocars, the abdominal cavity was inspected, and biopsy and/or abdominal lavage sampling was performed. Patients were allocated into three stages based on laparoscopic and histopathologic findings. Twenty-eight out of 68 patients were diagnosed as P1, 34 patients as P0CY0 and 6 as P0CY1. Based on these results, 57 patients underwent operation. The accuracy rate of diagnosis was 95% in the P category, and 93% in the CY category. Lavage telomerase activity was examined on 10 patients with P0CY0 gastric cancer. Two out of 10 were positive for this activity, and both of them had died due to peritoneal recurrence within a year after operation. In conclusion, the proposed diagnostic laparoscopic staging system is a simple and reproducible method for selection of a suitable therapy. It is considered that diagnostic laparoscopy under local anesthesia is a useful preoperative examination in cases of advanced gastric cancer. Moreover lavage telomerase activity may be a more sensitive predictor of peritoneal recurrence than lavage cytology.     

High prevalence of peritoneal metastasis in gastric cancer presenting gastric outlet obstruction: A new candidate for consecutive diagnostic staging laparoscopy and laparoscopic gastrojejunostomy

IntroductionGastric cancer presenting gastric outlet obstruction (GC-GOO) is associated with two problems to be considered in its treatment: peritoneal metastasis and an inability to intake food. Because peritoneal metastasis is difficult to identify in standard examinations, laparoscopic gastrojejunostomy (LGJ), which consecutively follows diagnostic staging laparoscopy (DSL), may be a minimally invasive solution to these diagnostic and therapeutic problems. However, whether GC-GOO is a new candidate for DSL has been not evaluated.Materials and methodsGC-GOO patients who were surgically treated at our department between 2005 and 2014 were recruited. Patient backgrounds, preoperative and surgical findings for distant metastasis, and surgical curability were retrospectively evaluated. To predict peritoneal metastasis, the sensitivity, specificity, and positive and negative predictive values of preoperative factors were calculated. The survival outcomes were also evaluated according to surgical curability and non-curative factors.ResultsA total of 237 patients with GC-GOO were included in this study. Among them, 167 patients had no distant metastasis identified preoperatively. Seventy-one of 167 patients underwent curative surgery while 75 (44.9%) had peritoneal metastasis including positive lavage cytology. Ascites and large type 3 or type 4 tumors indicated high specificity (86.9% and 76.1%, respectively) and the involvement of gastric angle presented high sensitivity (90.7%) for peritoneal metastasis. The overall survival of patients with incurable surgery was worse than that of patients with curative surgery, regardless of their incurable factors.ConclusionGC-GOO is a new candidate for DSL. DSL followed by LGJ may be proposed, utilizing preoperative predictive factors for peritoneal metastasis.     

Clinical significance of washing cytology in patients with advanced gastric cancer

Since 1988, we have performed intraoperative peritoneal washing cytology (CY) of the Douglas pouch in 1,255 patients (pts) with gastric cancer to diagnose latent peritoneal dissemination. Patients were classified as follows: 914 pts in P0, CY0; 100 pts in P0, CY1; 90 pts in P1; 53 pts in P2; and 98 pts in P3. Usually Papanicolaou's staining method was used and immunocytochemical staining of CEA and MOC-31 was carried out to make a definitive diagnosis. Prognostic factors were determined in 638 pts without liver metastasis by multivariate analysis. Curability, depth of tumor invasion, lymph node metastases, histological type and CY were independent prognostic factors. The survival of P0, CY1 pts who had undergone curative surgery was better than those with non-curative surgery. In conclusion, CY can serve as an independent predictor of prognosis, so immunocytochemical staining is important. P0, CY1 pts without residual cancer should be treated with multimodal therapy.     

Surgery after intraperitoneal and systemic chemotherapy for gastric cancer with peritoneal metastasis or positive peritoneal cytology findings

Background

Despite recent progress in systemic chemotherapy, the prognosis of gastric cancer patients with peritoneal metastasis (P1) or positive peritoneal cytology findings (CY1) is still poor. We developed a regimen combining intraperitoneal (IP) paclitaxel (PTX) with S-1 and PTX, which can produce notable efficacy with regard to peritoneal lesions. Surgery after response to combination chemotherapy is a promising option for P1 or CY1 gastric cancer. A retrospective study was performed to evaluate the safety and efficacy.

Methods

This study enrolled 100 primary P1 or CY1 gastric cancer patients treated with IP PTX plus S-1 and PTX at the University of Tokyo Hospital between 2005 and 2011. Radical gastrectomy was performed when peritoneal cytology findings became negative, and the disappearance or obvious shrinkage of peritoneal metastasis was confirmed by laparoscopy. The same chemotherapy regimen was restarted after surgery and repeated with appropriate dose reduction.

Results

Gastrectomy was performed in 64 (P1 56, P0CY1 8) of 100 (P1 90, P0CY1 10) patients. R0 resection was achieved in 44 patients (69%). The median survival time was 30.5 months [95% confidence interval (CI) 23.6–37.7 months] from the initiation of intraperitoneal chemotherapy and 34.6 months (95% CI 26.8–39.4 months) from the diagnosis of gastric cancer. Postoperative complications included anastomotic leakage and pancreatic fistula, each in two patients, which were cured conservatively. There were no treatment-related deaths. The median survival time of the 36 patients who did not undergo surgery was 14.3 months (95% CI 10.0–17.8 months).

Conclusions

Surgery after response to intraperitoneal and systemic chemotherapy is safe and may prolong the survival of P1 and CY1 gastric cancer patients.

     

Surgery after intraperitoneal and systemic chemotherapy for gastric cancer with peritoneal metastasis or positive peritoneal cytology findings

Background

Despite recent progress in systemic chemotherapy, the prognosis of gastric cancer patients with peritoneal metastasis (P1) or positive peritoneal cytology findings (CY1) is still poor. We developed a regimen combining intraperitoneal (IP) paclitaxel (PTX) with S-1 and PTX, which can produce notable efficacy with regard to peritoneal lesions. Surgery after response to combination chemotherapy is a promising option for P1 or CY1 gastric cancer. A retrospective study was performed to evaluate the safety and efficacy.

Methods

This study enrolled 100 primary P1 or CY1 gastric cancer patients treated with IP PTX plus S-1 and PTX at the University of Tokyo Hospital between 2005 and 2011. Radical gastrectomy was performed when peritoneal cytology findings became negative, and the disappearance or obvious shrinkage of peritoneal metastasis was confirmed by laparoscopy. The same chemotherapy regimen was restarted after surgery and repeated with appropriate dose reduction.

Results

Gastrectomy was performed in 64 (P1 56, P0CY1 8) of 100 (P1 90, P0CY1 10) patients. R0 resection was achieved in 44 patients (69%). The median survival time was 30.5 months [95% confidence interval (CI) 23.6–37.7 months] from the initiation of intraperitoneal chemotherapy and 34.6 months (95% CI 26.8–39.4 months) from the diagnosis of gastric cancer. Postoperative complications included anastomotic leakage and pancreatic fistula, each in two patients, which were cured conservatively. There were no treatment-related deaths. The median survival time of the 36 patients who did not undergo surgery was 14.3 months (95% CI 10.0–17.8 months).

Conclusions

Surgery after response to intraperitoneal and systemic chemotherapy is safe and may prolong the survival of P1 and CY1 gastric cancer patients.

     

Risk prediction model of peritoneal seeding in advanced gastric cancer: A decision tool for diagnostic laparoscopy

BackgroundSelective diagnostic laparoscopy in gastric cancer patients at high risk of peritoneal metastasis is essential for optimal treatment planning.In this study available clinicopathologic factors predictive of peritoneal seeding in advanced gastric cancer (AGC) were identified, and this information was translated into a clinically useful tool.MethodsTotally 2833 patients underwent surgery for AGC between 2003 and 2013. The study identified clinicopathologic factors associated with the risk of peritoneal seeding for constructing nomograms using a multivariate logistic regression model with backward elimination. A nomogram was constructed to generate a numerical value indicating risk. Accuracy was validated using bootstrapping and cross-validation.ResultsThe proportion of seeding positive was 12.7% in females and 9.6% in males. Of 2833 patients who underwent surgery for AGC, 300 (10.6%) were intraoperatively identified with peritoneal seeding. Multivariate analysis revealed the following factors associated with peritoneal seeding: high American Society of Anesthesiologists score, fibrinogen, Borrmann type 3 or 4 tumors, the involvement of the middle, anterior, and greater curvature, cT3 or cT4cN1 or cN2 or cN3, cM1, and the presence of ascites or peritoneal thickening or plaque or a nodule on the peritoneal wall on computed tomography. The bootstrap analysis revealed a robust concordance between mean and final parameter estimates. The area under the ROC curve for the final model was 0.856 (95% CI, 0.835–0.877), which implies good performance.ConclusionsThis nomogram provides effective risk estimates of peritoneal seeding from gastric cancer and can facilitate individualized decision-making regarding the selective use of diagnostic laparoscopy.     

Intraoperative peritoneal lavage cytology offers prognostic significance for gastric cancer patients with curative resection

Outcomes of patients with gastric cancer who exhibit positive peritoneal lavage cytology findings (CY⁺) vary by diagnostic methods because of quantitative and qualitative cancer cell diversity. This study sought to establish practical diagnostic criteria for performing curative resections, based on peritoneal lavage cytology findings in gastric cancer patients. We enrolled 1028 patients with gastric cancer who underwent R0/1 (n = 911) or R2 (n = 117) resections and analyzed relationships between cancer cell findings in peritoneal lavage fluid and clinicopathological factors in the R0/1 group. We found 68 patients with CY⁺ status. Receiver operating characteristic analyses and multivariate analyses showed that the presence of ≥1 signet ring cell, ≥5 cell clusters or ≥50 isolated cancer cells in peritoneal lavage fluid predicted poor prognoses in the 68 CY⁺ patients. High‐risk CY⁺ group patients with at least one of the above predictors had the highest hazard ratio (HR = 3.28, P < 0.001). The remaining (low‐risk) patients had a survival curve similar to that of patients with a normal cytology. The high‐risk CY⁺ patients who underwent R1 resection had poor prognoses despite no macroscopic peritoneal metastasis (2% 5‐year survival)—equivalent to that of patients who underwent R2 resection. The CY⁺ criteria defined in this study could help identify candidates for curative resection as an initial therapy for gastric cancer.     

Evaluation of positive cases with peritoneal lavage cytology in gastric cancer

Peritoneal dissemination with advanced gastric cancer is of significant problem. Peritoneal lavage cytology has been an effective method for the detection of early peritoneal dissemination since 1999. The accurate evaluation of peritoneal lavage cytology is unclear except for the same prognosis of peritoneal dissemination. We examined the clinical findings and the prognosis with positive cases in peritoneal lavage cytology. The prognosis of cases with P1CY1 or P2P3 group was poorer than in the P0CY1 or P0, CY1 group. We thus review the evaluation of peritoneal lavage cytology with gastric cancer in the Japanese and English literature. In addition, we describe the diagnosis of early peritoneal dissemination using peritoneal lavage tumor markers or molecular markers of peritoneal lavage.     

Prospective study to validate the clinical utility of DNA diagnosis of peritoneal fluid cytology test in gastric cancer

The clinical efficacy of DNA cytology test (CY) in gastric cancer (GC) has been retrospectively proposed using cancer-specific methylation of cysteine dioxygenase type 1 (CDO1). We confirmed the clinical utility of DNA CY in a prospective cohort. Four hundred GC samples were prospectively collected for washing cytology (UMIN000026191), and detection of the DNA methylation of CDO1 was assessed by quantitative methylation-specific PCR in the sediments. Endpoint was defined as the match rate between conventional CY1 and DNA CY1 (diagnostic sensitivity), and the DNA CY0 rate (diagnostic specificity) in pStage IA. DNA CY1 was detected in 45 cases (12.5%), while CY1 was seen in 31 cases (8.6%) of 361 chemotherapy-naïve samples, where the sensitivity and specificity of the DNA CY in the peritoneal solutions were 74.2% and 96.5%, respectively. The DNA CY was positive for 3.5/0/4.9/11.4/58.8% in pStage IA/IB/II/III/IV, respectively (P < .01). In the multivariate analysis, DNA CY1 was independently correlated with pathological tumor depth (pT) (P = .0012), female gender (P = .0099), CY1 (P = .0135), P1 (P = .019), and carcinoembryonic antigen (CEA) (P = .036). The combination of DNA CY1 and P factor nearly all covered the potential peritoneal dissemination (P1 and/or CY1 and/or DNA CY1) (58/61:95.1%). DNA CY1 had a significantly poorer prognosis than DNA CY0 in GC patients (P < .0001). DNA CY1 detected by CDO1 promoter DNA methylation has a great value to detect minimal residual disease of the peritoneum in GC clinics, representing poor prognosis as a novel single DNA marker.     

子宫内膜癌复发的影响因素分析及相应治疗方案

目的 探讨子宫内膜癌复发的影响因素,并制定相应的治疗方案.方法 比较分析135例子宫内膜癌手术治疗后出现复发患者与同期就治但未出现复发的135例子宫内膜癌患者复发的危险因素,并进行Logistic多因素回归分析.结果 病理分级、腹腔积液检测阳性、肌层浸润深度≥1/2、淋巴结转移、肉眼分型和宫旁转移与子宫后内膜癌复发相关(P＜0.05);年龄、病理分期和病理类型与其复发无关(P＞0.05).Logistic回归分析得出病理分级、肌层浸润深度、腹腔积液细胞学和淋巴结转移是影响子宫内膜癌术后复发的高危因素(P＜0.05).术后采取合适的辅助治疗能够提高长期生存率.结论 病理分级、肌层浸润深度、腹腔积液检测阳性和淋巴结转移是影响子宫内膜癌术后复发的高危因素.患者术后可选择适宜的辅助治疗,经常复查,及时处理、减少复发,提高术后生存率和生活质量.     

Role of staging laparoscopy with peritoneal lavage cytology in the treatment of locally advanced gastric cancer

Background More accurate preoperative staging is necessary to determine the treatment strategy for locally advanced gastric cancer. Laparoscopy has been suggested as an appropriate staging modality. The aim of this study was to clarify the role of staging laparoscopy in patients with locally advanced gastric cancer. Methods One hundred patients with primary gastric adenocarcinoma underwent laparoscopy with peritoneal lavage cytology. The disease stages determined were compared with those obtained by conventional methods. Results The disease stages were corrected after laparoscopy for 47 of the 100 patients (47%), with downstaging in 3 (3.0%) and upstaging in 44 (44%). Peritoneal deposits were found in 7 patients with peritoneal dissemination diagnosed by conventional examination. An unsuspected peritoneal deposit was found in 21 of 93 patients (22.6%), and unsuspected free cancer cells without deposits were found in 27 of 93 patients (29.0%). Gastrectomy after staging laparoscopy was performed in 39 patients. Laparoscopy showed no peritoneal deposits in any of these patients. Free cancer cells were found in 9 patients (23.1%), but 4 of these had peritoneal deposits at operation. R0 resection was performed in 34 of the 39 patients (87.2%). Neoadjuvant chemotherapy after staging laparoscopy was performed in 35 patients. All 35 patients underwent gastrectomy, which resulted in 27 R0 and 8 R2 resections. Of 18 patients with positive cytology at laparoscopy, 11 had no free cancer cells at operation. Neoadjuvant chemotherapy induced downstaging of the disease in 11 of the 18 patients with positive cytology (61.1%). Of 26 patients with massive peritoneal deposits, 4 underwent palliative resection because of pyloric stenosis. Twenty-two patients (22.0%) were able to avoid unnecessary laparotomy because of the staging laparoscopy. Conclusion Staging laparoscopy with peritoneal lavage cytology is a safe, effective tool in patients with locally advanced gastric cancer, especially in patients receiving neoadjuvant chemotherapy.     

胃癌患者腹腔游离癌细胞的检测及其临床意义

腹腔播散是进展期胃癌常见的转移方式,由于目前尚没有标准的检测胃癌腹腔微转移的方法,故大部分腹腔微转移的胃癌患者难以得到临床诊断。应用腹腔灌洗细胞学(PLC)检测腹腔游离癌细胞(IFCCs)的结果与腹腔镜检查结果相似,但是腹腔镜结合PLC可增加检查的敏感性。应用免疫组化和酶联免疫吸附试验可检测腹腔灌洗液(PLF)中IFCCs肿瘤标志,IFCCs预测胃癌复发的阳性预报值为91%,特异性为97%。应用免疫组化检测IFCCs是一个有效的、独立的预测胃癌生存期的阴性指标。应用酶联免疫吸附试验检测PLF中CEA水平是预测腹腔播散的指标,其诊断腹腔微转移的敏感性和特异性分别是75.8%和90.8%。应用PLF进行分子诊断的敏感性优于PLC、免疫组化和酶联免疫吸附试验。逆转录聚合酶链式反应(RTPCR)是一种新的诊断腹腔灌洗液中IFCCs的方法,基于靶基因的RTPCR方法可用于检测腹腔微转移的肿瘤分子标志。在IFCCs中表达的这些分子标志还可用于腹腔微转移治疗。存在IFCCs的胃癌患者的预后很差,无论应用哪种方法预测腹腔微转移都是困难的,但术前均应进行IFCCs检查,以明确诊断和指导治疗。     

Repeated intraperitoneal chemotherapy for peritoneal dissemination from gastric carcinoma

Repeated intraperitoneal chemotherapy (RIC) via an i.p. port system was carried out in 16 patients with peritoneal dissemination (P1) and in 10 with positive washing cytology (P0.CY1) from gastric carcinoma. CDDP dissolved in 500-1,000 ml of physiological saline solution was periodically administered via the i.p. port system. The change of washing cytology (CY), which was obtained from i.p. port, was examined before each administration as a indicator of the response. The average number of administrations was 5.7 and the average total dose was 301.7 mg. As a result, a negative change of CY after RIC was found in 74% of patients, and also more than 80% of the response occurred within three administrations. The prognosis tended to be better in P0.CY1 patients than in P1 patients. In particular, the median survival time of the CY responders markedly improved as compared with non-responders (27.8 months versus 7.1 months). Although diarrhea and anorexia of grade 3 developed once in each patient, serious toxicities were not found. In conclusion, we consider RIC to be an effective therapy for P0.CY1 among cases with peritoneal dissemination from gastric carcinoma.     

Neoadjuvant chemotherapy with S-1 and surgical resection for a mucinous gastric cancer with peritoneal dissemination

We herein report the case of a patient with mucinous gastric carcinoma with peritoneal dissemination that disappeared after neoadjuvant chemotherapy with S-1 alone. The patient has survived for over 23 months after surgery, without recurrence. A 60-year old man was referred to our hospital because of an advanced gastric cancer, detected by upper gastrointestinal endoscopy at another hospital. Staging laparoscopy was performed on October 25, 2002, and revealed massive peritoneal dissemination. Two courses of neoadjuvant chemotherapy with S-1 were administered, at 120mg/day for 28 days, as one course. Total gastrectomy, with D2 lymph node dissection, was performed on January 24, 2003. The peritoneal dissemination had macroscopically disappeared and the cytology of the peritoneal lavage fluid was class III. His final diagnosis was gastric carcinoma, MLU, type 3, T2(SS), P0, H0, M0, N3, CY0, stage IV.     

Strategy for patients with cytology positive and peritoneal dissemination from gastric cancer

The aim of this study was to evaluate the strategy for patients with cytology positive and peritoneal dissemination from gastric cancer. Thirty eight of POCY1, three of P1, eight of P2 and thirty six of P3 from advanced gastric adenocarcinoma at staging laparoscopy were studied. Gastrectomy after staging laparoscopy was performed in 10 patients (Surgery group). NAC following gastrectomy after staging laparoscopy was performed in 31 patients (NAC group) in POCY1, P1. The overall response rate was 29%, twenty of the 31 patients (65%) in the NAC group revealed no free cancer cells at the operation. The overall 5-year survival rate in 41 patients of POCY1, P1 was 15%. There was a significant deference in the overall survival curves between Surgery and NAC groups. The overall 2-year survival rate in 44 patients of P2, P3 was 9%. NAC for patients with positive cytology could lead into free cancer cells at a high rate, but not to improve their prognoses. An intensive chemotherapy including intra-abdominal chemotherapy should be necessary for these patients.     

Curative resection of gastric cancer: Limitation of peritoneal lavage cytology in predicting the outcome

Patients with stage T3N0～2M0 gastric carcinoma (n = 108) were studied for relevant prognostic factors. Peritoneal lavage cytology (PLC) was performed in all. In univariate analysis, 5-year survival rates were better with smaller serosal invasion (diameter <3.0 cm vs. ≥3.0 cm, 61% vs. 37%, P < 0.05) and fewer metastatic nodes (≤5 vs. ≥6, 57% vs. 29%, P < 0.05). In multivariate analyses, only these two factors were significant. The predictive value of PLC was not shown in both univariate and multivariate analyses. Peritoneal recurrence occured in 14 (22%) of 77 patients with negative PLC, and in 3 (18%) of 17 with positive PLC, the difference being not significant. Our results indicate that PLC is insensitive in predicting the development of peritoneal recurrence. Its role in the estimation of survival is limited, as many will die of visceral or locoregional recurrence if not of peritoneal dissemination.     

Risk Factors for Appendiceal Metastasis with Epithelial Ovarian Cancer

Purpose: To investigate the risk factors for appendiceal metastasis of epithelial ovarian cancer and comparefindings with the previous studies. Materials and Methods: One hundred and thirty-four patients withepithelial ovarian cancer were assessed in this study. All of them had undergone a surgical procedure includingappendectomy. Of these, 21 (15.7%) patients who had appendiceal metastasis were analyzed as the case groupand the patients with no metastasis were the controls, compared according to stage, grade, histology of tumor,preoperative Ca125 levels, presence of ascites, peritoneal cytology, diameter and site of tumor considered asrisk factors. Results: We found statistically significant differences between the groups in terms of stage, grade,right-sided tumor location, presence of ascites, diameter of tumor≥10 cm and positive peritoneal cytology(p<0.05). In the logistic regression model, stage, grade, presence of ascites, right-sided location and diameter oftumor were independent risk factors. ROC curve analysis showed that stage, grade and diameter of the tumorwere discriminative factors for appendiceal metastasis. Conclusions: In epithelial ovarian cancer, stage, grade,presence of ascites, right-sided location and large tumor size have importance for estimation of risk of appendicealmetastasis. As we compare our findings with previous studies, there is no definite recommendation for the riskfactors of appendiceal metastasis in epithelial ovarian cancer and more studies are needed.     

1992—1997年云锡矿工肺癌痰细胞学研究

目的,从痰细胞学角度研究1992－1997年云锡矿工肺癌,方法：应用医用数量统计法对云锡矿工肺癌高危人群（年龄龄大于等于40岁,坑冶龄大于等于10年）痰细胞学检查结果进行分析,,结果：6年确诊339例肺癌,鳞癌占56．34％,发病年龄平均为65．78岁,普查痰检阳性率为32．74％,准确率为88．35％,特异度为99．81％,灵敏度为39．22％,其阳性预测值962．01％）,显著优于X线检查方法（33．05）（P＜0．01）,共检出隐性肺癌48例,可疑隐性肺癌12例,结论：痰检仍是高危人群肺癌普查最有效的手段之一,建议重新划定职业高危人群界限（即年龄大于等于50岁,坑冶龄大于等于10年）。     

Preoperative laparoscopy by local anesthesia for advanced gastric cancer

Preoperative laparoscopy by local anesthesia was performed in 8 patients with advanced gastric cancer, whose lesions had been diagnosed to be more than T3 or suspected to have peritoneal seeding, and its usefulness was assessed. After insertion of the trocars, the abdominal cavity was inspected, and biopsy and/or abdominal lavage sampling was performed. Three patients out of 8 were diagnosed as P3, and 5 patients were diagnosed as P0 and CY0. Based on these results, 6 patients underwent operation. The accuracy rate of diagnosis was 83% in P category, and 100% in CY category. In conclusion, it is considered that laparoscopy by local anesthesia is a useful preoperative examination for advanced gastric cancer.